Resolution of severe intrapulmonary shunting after liver transplantation

A major complication of hepatic cirrhosis is arterial hypoxemia, often the result of intrapulmonary arteriovenous shunting. While previously such hypoxemia was thought to preclude successful hepatic transplantation, more recent studies have suggested that hepatic transplantation should be considered if the hypoxemia is corrected by supplemental oxygen. We report the findings in a cirrhotic patient with severe hypoxemia associated with intrapulmonary arteriovenous shunting. The patient did not respond to supplemental oxygen (PaO₂ < 40 mm Hg on O₂ at 4 L/min). The patient underwent successful hepatic transplantation, with complete resolution of intrapulmonary shunting. We believe that patients with cirrhosis-associated intrapulmonary shunting, even with hypoxemia resistant to supplemental oxygen, are acceptable candidates for hepatic transplantation.